Investigating the outcomes of cardiopulmonary resuscitation and factors affecting it: A cross‐sectional study at Dr. Moaven Hospital, Sahneh City from 2014 to 2021

Abstract Background and Aims Cardiopulmonary resuscitation (CPR) is referred to an attempt to maintain the respiratory system and blood circulation active to oxygenate the body's important organs until the heart and blood circulation system return to normal. CPR results are influenced by a variety of circumstances and factors. The purpose of this study was to look into the outcomes of CPR and the factors that influence them at the Dr. Moaven Hospital in Sahneh. Methods This cross‐sectional descriptive study was carried out retrospectively from the start of 2014 to the start of 2021. Kermanshah University of Medical Sciences provides hospitals with a two‐page form for data collection. After entering the data into SPSS24, descriptive and inferential statistical tests were applied to analyze the results. Results Out of 497 patients who referred to Dr. Moaven Hospital in Sahne City, 280 were men and 217 were women, with a resuscitation success rate of 22.5% in men and 23.5% in women. CPR was conducted on 63.2% of patients in the emergency department, with 22.2% of them having successful CPR. The existence of the underlying disease had a statistically significant link with the outcomes of CPR (p = 0.007). The most prevalent cause for visit was cardiorespiratory arrest (30.6%), and there was no statistically significant difference between the diagnostic and reason for visit and the outcome of resuscitation, according to the χ 2 test. Conclusion According to the findings of this study, increasing age and duration of CPR, the existence of underlying diseases, and the absence of shockable rhythms all reduce the likelihood of success in CPR.


| INTRODUCTION
Cardiopulmonary arrest, which can occur at any time and in any place, is among the most prevalent causes of death worldwide. 1 Every year, Approximately 300,000 people in the United States suffer from out-ofhospital cardiac arrest. 2 Despite considerable breakthroughs in the prevention of cardiac arrest, it is still regarded as the most serious health problem and the leading cause of death in the majority of countries around the world. 3 Correct and rapid cardiopulmonary resuscitation (CPR) can reverse a vast number of cases of cardiopulmonary arrest. CPR of high quality improves the patient's chances of survival. 4 However, many healthcare personnel are unable to execute optimal and high-quality CPR, and CPR outcomes continue to be low globally. 4,5 Correct and principled CPR serves as the foundation for subsequent actions. 6 In fact, successful CPR is dependent on treatments performed outside the patient's body to establish blood flow for oxygenation of the body's vital organs. 7 Although the desired outcome of successful CPR is the patient's full return to life, 8 people's survival rates are much lower, particularly in out-of-hospital resuscitation. 9,10 Various factors, which vary by country, are effective in CPR. 11 The duration of the cardiorespiratory arrest until the initiation of CPR, underlying diseases, the availability of professional and trained resuscitation personnel, and the requisite tools and equipment are all effective factors. 12 The place and time of the cardiorespiratory arrest are additional critical factors. 13 In some research, the underlying cause is regarded as an important factor. 1,14 Age, gender, purpose for visit, use of defibrillation, and other characteristics all have an impact. 15,16 Age and gender cannot be changed, but factors such as minimal waste of time at the start of resuscitation operations, timely use of defibrillators, employees' level of knowledge and experience, and pharmaceutical interventions are among the factors that can increase the probability of patient survival with appropriate intervention. 15

| MATERIALS AND METHODS
In this descriptive cross-sectional study, 497 cases of CPR from the beginning of 2014 to the beginning of 2021 were examined retrospectively. During the 7 years, all patients with cardiorespiratory arrest who visited Dr. Moaven's Hospital in Sahneh City were studied. Patients who were not allowed to finish resuscitation by attendants and patients who just encountered respiratory arrest were excluded from the study. The data collection instrument was a twopage form provided to hospitals by Kermanshah University of Medical Sciences that was filled out at the patient's bedside by supervisors who had been trained in this field and included demographic information about the patient, underlying disease, diagnosis, CPR process, drugs and equipment used, and the outcome of resuscitation, and so forth. Furthermore, a copy was filed in the nursing office where the researcher went to the research environment after obtaining the code of ethics and permission to begin research (990621) from Kermanshah University of Medical Sciences and used the registration forms for the resuscitation operation report and to access more complete information, the patients' files were referred to and the necessary information was extracted and recorded. After entering the data into the SPSS24, descriptive and inferential statistical tests were used to analyze the results. The impact of gender on resuscitation outcomes was not significant in this study. Eight percent of the patients who had successful CPR were resuscitated, with 27.5% having successful resuscitation. There was not a significant relationship between resuscitation history and the outcome of CPR. In the hospital, 68.2% of cases of cardiorespiratory arrest occurred, with 25% having successful resuscitation, and 31.8% occurring outside the hospital, with 18.3% having successful CPR. The χ 2 test revealed that there was no statistically significant difference between the location of the cardiorespiratory arrest (within or outside the hospital) and the outcome of resuscitation. CPR was conducted on 63.2% of patients in the emergency department, with 131 cases related to the general department of men. In maternity and pediatric departments, the least quantity of resuscitation was conducted (0.2%). The CPR success rate was 22.2% in the emergency department and 24% in other departments, with a statistically significant relationship between the unit that performed the resuscitation and the resuscitation outcomes (p = 0.007).

| RESULTS
In terms of underlying diseases, 18.7% of the patients had high blood pressure, 16.9% had diabetes, 19.7% had cardiovascular diseases, 15.2% had other diseases, and 29.5% did not have any underlying disease, and there was a significant relationship between underlying disease and CPR outcomes (p = 0.007%). The patients' disease diagnosis and reason for the visit were divided into nine categories, which included cardiorespiratory arrest, cardiovascular diseases, neurological diseases, accidents and trauma, respiratory arrest, internal diseases, cancer, suicide, and the ninth category also included patients whose cause of cardiopulmonary arrest was in two or more groups. The most common reason for a visit was cardiorespiratory arrest (30.6%) and cardiovascular diseases (17.7%), while suicide (3.6%) was the least common reason for a visit. The most successful resuscitations were performed on suicide by poisoning (medicine and poison) (38/8), whereas the least successful were performed on accident and trauma patients (12/5).
The χ 2 test revealed no statistically significant difference in the diagnosis, the reason for visit, and outcome of resuscitation. In 73/8 of the cases, the CPR operation began less than 1 min after the operation code was announced. 17.5% of CPR lasted less than 30 min, 69.6% lasted between 30 and 60 min, and 12.9% lasted longer than 60 min (Table 1).
There was a statistically significant relationship between the duration of CPR and the outcome of CPR (p = 0.000). There was a statistically significant relationship between receiving a defibrillator and the outcome of resuscitation (p = 0.000) among the patients who received a defibrillator (55.4 had a final response to the defibrillator).
At the time of admission, 77.7% of patients had no cardiac rhythm (asystole), 5.6% had PEA rhythm (pulseless electrical activity), 8% had VT rhythm, and 7.8% had VF rhythm. CPR was successful in 37.5% of patients with VT rhythm and 27.6% of patients with VF rhythm. The

| DISCUSSION
Cardiac arrest is defined as a halt in blood circulation in which the heart muscle does not contract and there is no outflow or flow of blood. CPR is an attempt to artificially maintain the circulatory and respiratory systems working so that enough oxygen is delivered to keep the body's vital organs alive. 19 The current study was designed to look into the outcomes of CPR and the factors that influence them one study, with an initial success rate of 58.91%. 22 The initial success rate of CPR was reported as 36.7% in a study conducted by Nazri panjaki et al. 1 According to some studies, the initial success rate of resuscitation is 25.4%. 15 The reason for this center's lower success rate of CPR compared to other centers in the country is that some patients who came to the emergency room were completely dead, and due to cultural conditions and the insistence of the companions, the personnel were forced to perform resuscitation operations, which in some cases has resulted in a decrease in the overall success rate. visualization.

ACKNOWLEDGMENTS
All participants in this study are appreciated.

CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
All the data are available from the authors through reasonable request.

ETHICS STATEMENT
The undertaken procedures were approved by the Medical Ethics Committee of Kermanshah University of Medical Sciences IR.KUMS.-REC.1398.320. Consent to submit has been received explicitly from all coauthors, as well as from the responsible authorities-tacitly or explicitly-at the institute/organization where the work has been carried out, before the work is submitted. The purpose of this research was completely explained to the participants through the cover page of the questionnaire, and they were assured that their information would be kept confidential by the researcher. Informed consent from the participants was acquired as they agreed to participate in the study by reviewing the questionnaire's cover page and clicking on the provided link. Furthermore, for participants younger than 18 years of age, the participant was asked for the consent of the parent or guardian.

TRANSPARENCY STATEMENT
The lead author Arash Ziapour affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.